Flu Season 2020-2021 Has Arrived
The 2020-2021 flu season began on 8/1/2020.
The Medicare flu billing codes and fees along with the brand name and manufacturer are located on the CMS Seasonal Influenza Vaccines Pricing web page.
Please note: The NDCs change each influenza season. The NDC must be included in Loop 2410 LIN segments of the electronic claim (Item 19 on the CMS-1500 paper claim). Each box of vaccine includes the NDC assigned by the manufacturer. The correct NDC and HCPCS code for the influenza vaccine must be billed in order for your claim to process, incorrectly billed claims will be denied.
The administration code for the influenza vaccine is G0008 and is not subject to the Medicare deductible or coinsurance. Billing codes 90471 or 90472 will result in claim denial.
Please review and use the appropriate flu vaccine code to avoid processing delays and claim denials.
Payment Allowances and Effective Dates for the 2020-2021 Flu Season
| Code | Labeler Name | Vaccine Name | Payment Allowance | Effective Dates |
|---|---|---|---|---|
|
90653 |
Seqirus | Fluad (2020/2021 | $59.529 | 8/5/2020 – 7/31/2021 |
| 90694 | Seqirus | Fluad Quadrivalent (2020/2021) | $61.000 | 8/5/2020 – 7/31/2021 |
| 90662 | Sanofi Pasteur | Fluzone High-Dose Quadrivalent (2020/2021) | $ 60.982 | 8/5/2020 – 7/31/2021 |
| 90672 | MedImmune | FluMist Quadrivalent (2020/2021) | $26.876 | 8/12/2020 – 7/31/2021 |
| 90674 | Seqirus | Flucelvax Quadrivalent (2020/2021) (Pres Free) | $29.228 | 8/12/2020 – 7/31/2021 |
| 90682 | Sanofi Pasteur | Flublok Quadrivalent (2020/2021) | $60.982 | 8/1/2020 – 7/31/2021 |
| 90685 | Sanofi Pasteur Seqirus |
Fluzone Quadrivalent 0.25ml (2020/2021) (Pres Free) Afluria Quadrivalent 0.25ml (2020/2021) (Pres Free) |
$21.129 | 8/1/2020 – 7/31/2021 |
| 90686 | GlaxoSmithKline Sanofi Pasteur Seqirus |
Fluarix Quadrivalent (2020/2021) (Pres Free) Flulaval Quadrivalent (2020/2021) (Pres Free) Fluzone Quadrivalent (2020/2021) (Pres Free) Afluria Quadrivalent (2020/2021) (Pres Free) |
$19.581 | 8/1/2020 – 7/31/2021 |
| 90687 | Sanofi Pasteur Seqirus |
Fluzone Quadrivalent 0.25ml (2020/2021) Afluria Quadrivalent 0.25ml (2020/2021) |
$9.584 | 8/1/2020 – 7/31/2021 |
| 90688 | Sanofi Pasteur Seqirus |
Fluzone Quadrivalent (2020/2021) Afluria Quadrivalent (2020/2021) |
$19.168 | 8/1/2020 – 7/31/2021 |
| 90756 | Seqirus | Flucelvax Quadrivalent (2020/2021) | $27.695 | 8/12/2020 – 7/31/2021 |
Posted 8/26/2020